慢性心力衰竭患者血清脑利钠肽水平的变化及其临床意义

Changes and clinical significance of serum brain natriuretic peptide le vels in patients with chronic heart failure

目的 :探讨慢性心力衰竭 (心衰 )患者血清脑利钠肽 (BNP)水平变化及其临床意义。方法 :用酶联免疫吸附法 (ELISA)检测 72例慢性心衰患者 (心衰组 )和 30例健康成人 (对照组 )血清BNP 32浓度 ,并动态观察心功能分级 (NYHA)Ⅲ级、Ⅳ级患者治疗2wk后BNP 32水平变化。比较不同NYHA分级与不同病因的BNP水平差异 ,以及治疗前后的动态变化。结果 :(1)心衰组BNP水平 85 8.7±32 6 .9ng·L-1明显高于对照组 10 9.3± 37.6ng·L-1(P <0 .0 1)。心衰组和对照组的BNP水平的 95 %可信区间 (CI)分别为 781.9～ 935 .5ng·L-1和 95 .3～12 3.3ng·L-1,相互之间无交叉。 (2 )血清BNP水平对慢性心衰的诊断界值为 12 0ng·L-1时 ,其灵敏度和特异性分别为 10 0 %和 87%。 (3)NYHAⅡ级、Ⅲ级和Ⅳ级的BNP水平分别为 6 38.5± 2 2 4 .5、878.0±334.0和 10 4 5 .8± 5 85 .1ng·L-1(P <0 .0 1) ,BNP水平与NYHA分级呈正相关 (r =0 .818,P <0 .0 1) ,与原发病无相关性 (P >0 .0 5 )。 (4 )BNP水平较高的患者预后差 ,治疗后BNP水平下降者疗效较好 ,反之疗效差。结论 :BNP水平对慢性心衰患者的诊断、病情和治疗效果评估、预后判断具有重要临床意义。

AIM: To investigate the changes and clinical sig ni ficance of serum brain natriuretic peptide (BNP) levels in patients with chronic heart failure. METHODS: ELISA method was used to measure the se rum levels of BNP-32 in 72 patients with chronic heart failure (HF group) and 3 0 healthy subjects served as control group. 46 patients with New York Heart Asso ciation (NYHA) class Ⅲ and class Ⅳ were measured repeatly after 2-weeks treat ment. The differences between BNP levels and different NYHA classes or underlyin g diseases were analysed. The changes of BNP levels before and after treatment i n the same patients were also compared. RESULTS: (1) The serum l evels of BNP in HF group and control group were 858.7 ± 326.9 and 109.3 ± 37.6 ng·L -1 , and the 95% confidence interval of both group were 781.9 - 935.5 and 95.3 - 123.3 ng·L -1 , respectively (P< 0.01 ). (2) The sensitivity and specificity of BNP cut-off valu e of 120 ng·L -1 for diagnosing chronic heart failure were 100% and 8 7%. (3) BNP levels in NYHA classⅡ, Ⅲ and Ⅳ were 638.5 ± 224.5 , 878.0 ± 334.0 and 1045.8 ± 585.1 ng·L -1 , respectively (P < 0.01 ). The levels of BNP increased markedly with NYHA class highte ning (r= 0.818 , P< 0.01 ). CONCLUSION: The levels of BNP are significantly increased, and correlated with the NYHA class, a s well as with prognosis in patients with HF. After treatment, falling BNP level s in patients show good outcomes, whereas elevating BNP levels in patients show bad outcomes. The level of BNP has important value in diagnosis, therapentic eff icacy and prognosis of patients with chronic heart failure.